POS0719 MATERNAL AND PERINATAL OUTCOMES IN WOMEN WITH VASCULITIS - A 13-YEAR EXPERIENCE FROM A PORTUGUESE TERTIARY CENTRE
Authors: A. R. Lopes, A. R. Cruz-Machado, S. C. Barreira, P. Martins, C. Araújo, M. Centeno, C. Ponte, L. Pinto, S. Capela
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The vasculitides are rare conditions that may affect women of childbearing age. These women seem to be at increased risk for developing adverse pregnancy outcomes (APO). Maternal and perinatal outcomes as well as their optimal management during pregnancy remain poorly understood in this population. <h3>Objectives</h3> To describe maternal and perinatal outcomes in women with vasculitis. <h3>Methods</h3> Observational retrospective study including pregnant women with vasculitis followed at a rheumatology-obstetric clinic from 01/2009 to 06/2022. <h3>Results</h3> We identified 31 pregnancies in 24 women with vasculitis. Table 1 summarizes demographic and clinical data. The most frequent diagnosis were Behçet's disease (BD) (18; 58%), polyarteritis nodosa (PAN) (4; 13%) and Takayasu arteritis (TAK) (4; 13%). The mean ± SD age at conception was 33 ± 6 years with a median disease duration of 6 (IQ range 3-12) years, 29 (94%) were in remission by the time of conception. We documented 30 live births, 1 early miscarriage (BD) and there was no perinatal mortality or birth defect. The mean ± SD gestational age at delivery was 38.2 ± 2.1 weeks. Five (17%) viable pregnancies resulted in preterm births - 3 BD, 1 TAK and 1 relapsing polychondritis (RP). Fetal growth restriction was detected in 2 (6%) pregnancies (TAK and RP). Eight (30%) newborns were small for gestational age (SGA), most of them from mothers with BD (4; 29%). Cesarean section (CS) was performed in 8 (26%) patients – 2 (TAK) due to vasculitis activity. Nine (36%) patients relapsed during pregnancy (4 BD; 2 PAN; 1 TAK; 1 RP; 1 ANCA-PR3 cutaneous vasculitis) while 6 (22%) relapsed during the post-partum period (4 BD; 1 TAK and 1 RP). A total of 24 (77%) patients were treated with glucocorticoids (GC), most of them (63%) at low doses (≤5mg/day of prednisolone or equivalent). Seven (23%) patients were treated with conventional DMARDs: 2 TAK and 3 BD with azathioprine and 2 PAN with azathioprine and hydroxychloroquine. Biological DMARDs were prescribed in 2 (6%) patients, both with the diagnosis of TAK: one with a multisegmental aortic disease who received tocilizumab during the first 30 weeks of gestation (WG) and had an uneventful pregnancy, and another patient with an ascending aortic aneurism (AAA) who also received tocilizumab, but from the 24<sup>th</sup> week onwards showed a gradual worsening of the AAA dimensions (maximum 56 mm). An elective CS at 32 WG was performed in the latter case due to the high risk of aneurysm rupture and a healthy baby with 1900g was born. The occurrence of flares during pregnancy increased the risk for APO (OR 13, 95 CI 2-80; p=0.007). No association was found concerning maternal age or use of DMARDs/GC and the risk of APO (p&gt;0.05). <h3>Conclusion</h3> Most pregnant women with vasculitis managed at out multidisciplinary unit had successful gestations. However, they may still be at risk for developing APO, namely if they experience disease flares during gestation. SGA was the main APO recorded. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.